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Sanders, Cruz, and Ideology in the Healthcare Debate

Last night, while the Senate was silencing Elizabeth Warren — turns out Republicans need their safe spaces too, huh? — two of its members were down the road at George Washington University debating health care.

The debate, hosted by CNN, pitted Bernie Sanders and Ted Cruz against each other for a discussion on the future of the Affordable Care Act, and, more broadly, the future of American healthcare.

If you watched the two men during their Presidential runs last year, the debate was not revelatory. Both Sanders and Cruz have well-established positions on health care.

But the event was still a fascinating anomaly in American politics: It matched two politicians who aren’t running for anything in a two-hour discussion of a single policy issue.

And what the debate revealed, more than any news — the Republicans still have no idea how they want to replace Obamacare, which likely isn’t going anywhere for the time being — was a fundamental difference in values between the two participants.

Sanders is operating on a utilitarian basis: He wants as many people as possible, preferably everyone, to be covered. If that means that those at the top have worse coverage than they have now, or have to pay more for it, that’s the cost of doing business.

Cruz, on the other hand, wants everyone to be able to pursue the best coverage possible — knowing full well that, due to a preexisting condition, age, the economy, bad luck, whatever, a lot of people are going to end up with approximately nothing.

Sanders, of course, believes — and the U.N. agrees — that health care is a basic human right. Cruz, quite simply, does not.

It’s a moral disagreement. But while Democrats often get hit with the accusation that their political positions are all morality plays — the “facts don’t care about your feelings” argument — Cruz’s position is also a moral one.

It’s just a different judgement. Arguably less empathetic, but no less legitimate.

Republicans frequently stray from their ideology, which is inherently flawed anyway — it’s difficult to pull yourself up by your bootstraps if you don’t have health care, a good education, and can’t easily vote, for instance — but it’s a common jumping off point.

All politics and law is grounded in a base morality — a sense of justice, of what’s right and what’s wrong.

Conservatives make moral judgements all the time. Judicially, that’s how we got separate but equal and a “colorblind” Constitution. It’s how they come by their stance on abortion and education. The death penalty, too.

The Democrats aren’t the only ones who care about feelings and fairness. The Republicans do too.

During one of the most heated moments of the two-hour show, Cruz said that people should have access to health insurance. Sanders replied that access doesn’t mean much — or, in his parlance, “doesn’t mean a damn thing” — if you don’t actually end up with insurance.

There too is a moral dichotomy. Is it the process that determines fairness? Or the outcome? So, while Sanders and Cruz presented competing economic visions last night, but they also presented competing moral visions.

Medicare coverage isn’t great — though it might be worth mentioning here that life expectancy in the U.S. is lower than it is in countries with universal coverage like Canada, the U.K., and France. Meanwhile, the private market produces very good care and leaves millions of people out in the cold. Take your pick as to which is worse.

Of course, the healthcare debate is far more complex, nuanced, and wide-ranging than that. There are questions of price and efficiency and quality, and also, even between Cruz and Sanders, points of agreement.

Both Senators, for one, voted for an amendment introduced by Sanders in January that would have allowed Americans to buy cheaper drugs from Canada. The amendment was defeated 52-46, with leading Democrats who are funded by big pharma — such as Cory Booker and Patty Murray — voting it down.

There’s also the short-term debate on the future of the ACA. Obamacare has insured more than 20 million Americans since its passage in 2010 and provided a lifeline to some of our most vulnerable citizens. According to Vox, 20% of the people whose lives were saved by Obamacare, for example, are HIV-positive.

But, as even its most ardent defenders will admit, it has its fair share of problems.

Cruz and Sanders argued their points well. They are both, despite all appearances to the contrary, tremendously skilled politicians.

Cruz finished second in a field of seventeen Republican Presidential candidates despite his — let’s call a spade a spade — general unbecomingness; while Sanders, at 75, nearly won the Democratic nomination for President as a self-described Socialist.

Perhaps this moral argument is a ridiculous one to be having right now. After all, Republicanism in 2017 has nothing to do with traditional conservatism. This is a party that, last night, decided to silence and censure the voice of Coretta Scott King on the floor of the Senate.

Cruz — him again — weighing in on the situation this morning, called Democrats “out of their minds,” “foaming at the mouth,” and “the party of the Ku Klux Klan.”

Also, the President appears to be mentally ill.

So ideological battles are not quite the order of the day. Right now, it’s general decency and sanity against a man who this week placed a 3:00 am phone call to his National Security Advisor to ask if we’d rather have a strong or weak dollar.

But it’s as important as ever that we don’t lose track of what we’re fighting for and why we’re fighting for it. Sanders’ popularity stems in large part from the fact that, no matter how you weigh the merits of his arguments, he never has.

Morality in these debates is not one-sided. It is, for everyone who takes part, a crucial driver of political activity and thought.